ESRD drug coverage for Medicare patients
(Grand Rapids, Mich. - March 23, 2011)
The Centers for Medicare and Medicaid Services recently determined that some drugs are always considered renal dialysis drugs when prescribed for a patient with end stage renal disease (ESRD) and used as specified in the table below.
These drugs now require a Part B vs. Part D coverage determination before they're covered by Priority Health Medicare.
| Drug category | Drug use |
|---|
| Access management |
Drugs used to ensure access by removing clots from grafts, reverse anticoagulation if too much medication is given and provide anesthetic for access placement. |
| Anemia management |
Drugs used to stimulate red blood cell production and/or treat or prevent anemia. |
| Anti-infectives |
Vancomycin and Cubicin (daptomycin) used to treat access site infections. |
| Bone and mineral metabolism |
Drugs used to prevent/treat bone density disease secondary to dialysis. |
| Cellular management |
Drugs used for deficiencies of naturally occurring substances needed for cellular management. |
Request a coverage determination
We sent letters to our members who are taking these drugs to let them know their coverage may change. We suggested they ask their provider to contact us for a coverage determination. You can request a coverage determination by:
Read the CMS memo
Clarified ESRD Guidance, 02/17/2011. This PDF will open in a new browser window.
